Objectives: With the advancement of medical technology, various life-sustaining treatments are available to older adults. Consequently, it is increasingly essential that older adults are involved in determining the level of care they receive at the end of life. The study’s objectives were (a) to explore the end of life treatment preferences of older adults living in a continuing care retirement community; (b) to determine consistency of end of life preferences over time; and (c) to explore the relationships between end of life preferences and demographics, religion, physical health, and mental health.
Design: The study used a single group repeated measures design, which included a sample of ninety older adults living independently in a continuing care retirement community (CCRC). The participants were recruited during the annual residential health fair. All facility residents were eligible to participate in the study. Residents were excluded, however, if they scored below twenty on a screening mini mental status exam. Graduate nursing students conducted three interviews at twelve-month intervals. The interviews were privately performed in the participant's apartment or in the outpatient health care center office.
Population, Sample, Setting, and Years: Baseline interviews were completed on 158 residents living in an east coast CCRC. Over the three-year period, a total of sixty-eight residents were excluded due to death or placement into a long-term care facility. The remaining sample of ninety older adults completed all three surveys. The majority of the participants were female (82%), unmarried (79%), Caucasian (99%), and Christian (80%). The participants’ mean age at baseline was 85.0 ± 5.0.
Concepts or Variables Studied: The participant’s health and cognitive status were evaluated. They answered questions pertaining to end of life preferences (ELTP), physical health, and mental health. Specifically, each participant was questioned about receiving cardiopulmonary resuscitation, having major surgery, placement on a respirator, receiving dialysis, receiving a blood transfusion, receiving artificial nutrition and hydration, undergoing diagnostic testing, receiving antibiotic treatment, and receiving pain medications in the event of medical necessity. The above treatment options were included in the survey, because they are frequently encountered in clinical practice and repeatedly used in other tools (Walker, Schonwetter, Kramer, & Robinson, 1995). The response options included (a) I want the intervention; (b) I want the intervention started but stopped if there is no improvement in my condition; (c) I am undecided; and (d) I do not want the intervention.
Methods: Descriptive data were collected on demographic variables. Repeated measure analysis of variance was used to test differences in willingness to engage in end of life care activities over the three years. Regression analyses were used to test the relationship between various variables (age, gender, marital status, mental status, physical and mental health, and religion) and ELTP at each test year.
Findings: At baseline, most participants did not want cardiopulmonary resuscitation (54%), ventilation by respirator (53%), or dialysis (53%), but they were willing to have surgery (53%), blood transfusions (69%), pain medication (80%), antibiotics (96%), and diagnostic tests (97%). Although thirty-seven (41%) participants did not want artificial nutrition and hydration, twenty-six (29%) were willing to receive artificial nutrition and hydration. Over the three testing years, there was a statistically significant decline in older adults wanting artificial nutrition and hydration, surgery, and ventilation by respirator. There was no change in ELTP related to wanting pain medications, antibiotics, diagnostic tests, blood transfusions, cardiopulmonary resuscitation, and dialysis.
Conclusions: There was no relationship between gender, marital status, mental or physical health, cognitive status or religion with the number of ELTP that the older adult was willing to accept. The majority of the participants did not want life sustaining treatments such as ventilation by respirator, cardiopulmonary resuscitation, or dialysis. Almost half of the participants did not want artificial nutrition and hydration at the end of life.
Implications: The study’s findings indicate that most older adults prefer comfort measures, rather than aggressive life-sustaining treatments. Therefore, nurses should discuss end of life treatment preferences with older adults. The nurse should periodically review specific treatment options such as artificial nutrition, ventilation by respirator, and surgery, since patients wanting these options significantly declined over time. Finally, older adults should be encouraged to have advance directives dictating their end of life preferences, because improving medical and technical knowledge increases an older adults end of life treatment options.
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